Partially reversible renal tubular damage in patients with obstructive jaundice

• Published in: Hepatology (Baltimore, Md.) Vol. 33; no. 6; pp. 1365 - 1369
• Main Authors: Bairaktari, Eleni, Liamis, George, Tsolas, Orestes, Elisaf, Moses
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.06.2001; W.B. Saunders; Wiley
• Subjects: Adult; Bile Acids and Salts - blood; Biological and medical sciences; Cholestasis - blood; Cholestasis - pathology; Cholestasis - physiopathology; Cholestasis - urine; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Kidney Tubules, Proximal - pathology; Kidney Tubules, Proximal - physiopathology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Magnetic Resonance Spectroscopy; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Phosphates - blood; Phosphates - urine; Prospective Studies; Reference Values; Uric Acid - blood; Uric Acid - urine; Kidney disease; Human; Biliary tract; Urinary system disease; Renal function; Biliary tract disease; Statistical study; Obstruction; Renal tubule; Dysfunction; Cholostasis; Digestive diseases; Complication; Reversibility
• ISSN: 0270-9139; 1527-3350
• DOI: 10.1053/jhep.2001.25089

Decreased serum uric acid levels resulting from renal urate wasting have been occasionally encountered in jaundiced patients. However, in these cases, there are no data concerning the underlying renal tubular defects. In the present study, we investigated the renal tubular function in 35 patients with obstructive jaundice of various severity and causes (11 with lithiasis, 17 with carcinoma, and 7 with intrahepatic cholestasis). A detailed study of the renal tubular function was performed. Beyond the conventional methods, 1H-NMR spectroscopy of urine was used to evaluate noninvasively renal damage by the characteristic perturbation in the excretion pattern of low-molecular weight endogenous metabolites. On admission, patients with obstructive jaundice had significantly lower serum uric acid and phosphate levels and higher bile acid concentrations compared with 40 age- and sex-matched controls. Serum uric acid levels presented a negative correlation with the total and direct bilirubin as well as the fractional excretion of uric acid. Furthermore, a great number of the patients studied developed one or more proximal tubular dysfunction manifestations beyond uricosuria, such as renal glucosuria, phosphaturia, and increased excretion of α1-microglobulin. 1H-NMR spectroscopy of the urine showed decreased levels of citrate and hippurate and increased levels of 3-hydroxybutyrate and acetate. In 12 patients partial or complete remission of jaundice was followed by an improvement of the proximal renal tubular damage. In conclusion, obstructive jaundice can cause a partially reversible generalized proximal tubular dysfunction. (HEPATOLOGY 2001;33;1365-1369.)